Absence of joy: A doctor’s journey with depression

The scene was picture perfect, an absolute characterization of a tropical island paradise.  White deserted beach, overhanging palm trees, crystal clear, gentle lapping waters, and a blood red sun sinking slowly into a Fijian ocean.

I found no pleasure in it.  Perhaps it was the heat, or that my new wife and I had been travelling for six months?  Or that we had been on many other tropical islands and amazing places in the eighteen months we had set aside to see the world on a working and travelling holiday?

I remember feeling surprised that the joy of the moment was missing, and at the time I could not understand why. I wondered, with some indifference, what it would feel like to walk into the water, to swim towards the setting sun, and never to return.

It would be another ten years before I would understand the absence of joy that this moment typified.  In the meantime I began and finished my specialisation, had two children, moved to my present town, another paradise every bit as special as the beaches of Fiji, and opened a private practice.

For ten years I fought against the feeling that for long periods of time I was abnormally unimpressionable.  Not all the time, but certainly for moments. I was neither incredibly happy nor depressingly sad.  I put all this down to the stresses of making ends meet by moonlighting in ER’s, working impossible hours, studying for interminable exams, followed by the stresses of looming loan repayments, cash flow crises, parenting and marriage demands as my practice struggled to find its feet.

During moments of reflection I would question my condition, briefly consider depression as a factor, and then disregard it completely.  I was sleeping well.  I was not miserable.  Just stressed, like many of my colleagues.  Burn out was the diagnosis I chose for myself, and there seemed to be no easy option to deal with that.

But as the joy withdrew from my life, I was unable to identify the cause within.  I looked for other causes.  If the reason was not internal, it had to be external.  I found subtle fault with everyone around me, my wife, my kids, my career, my patients, my staff.  I considered changing my situation, leaving all of these, building another life, because this one did not appear to make me happy.

My wife saved me from myself.  Some ultimatums later, I was presented with a diagnosis of subclinical depression and began taking an SSRI.

Initially I was devastated by the diagnosis.  I concealed my medication, bought it from pharmaceutical suppliers so there would be no record to come back to me that would impact on insurance or my reputation.  I hid the fact from my own doctors and especially from my colleagues.  But slowly the realisation dawned that I am not my condition, and my illness – I don’t think of it as such – does not define me.  And I relaxed.

To say my life has changed would be an understatement.  The mood swings are gone.  The joy has returned.  Stress is still there, but it washes off like water off a duck’s back.  My relationships are better.  All for the cost of taking a small white tablet.

So why am I sharing this?  Professional men are especially vulnerable to this condition, and least likely to recognise it. Depression in its earliest forms often manifests as an absence of joy, when the things that used to bring pleasure no longer do so.  It is then easy to think that external factors are responsible for a lackluster life, and to blame other people rather than ourselves.  So men look beyond their wives and families for what is missing.  We become ratty, bad tempered, stressed, burnt out.  Relationships and marriages are at stake.

So men, if you no longer find pleasure in the things that you used to, absence of joy, you may be like me, and one step away from rediscovering it.  See someone about it!

I was lucky.  I learned the real reason behind my perception of the world around me, and treatment has been really simple and effective.

And I wish that I could be back on that sunset beach in Fiji, to see that scene as it really is, and not what I perceived it to be.

That would be lost joy restored completely.

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